What do Institutional Claims error responses look like?

If something is wrong with the syntax of the data, you may get a response from our validation endpoint like the below:

{
    "errors": [
        {
            "field": "claimInformation.validReleaseInformationCode",
            "description": "Allowed Values are: 'I' Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes,'Y' Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim"
        }
    ]
}

The error is in the claimInformation object's validReleaseInformationCode attribute. The API also lists out the permissible values that you can apply to correct the error (of course, the chosen value must be correct in the context of the claim).

If the syntax is correct but an error in the format of the claim makes it to the clearinghouse, you may get a response from our Edit engine similar to the following:

{
    "status": "EDITS",
    "controlNumber": "000000001",
    "tradingPartnerId": "RANDOM_ID",
    "tradingPartnerServiceId": "9496",
    "claimReference": {
        "correlationId": "200331R999898~1612903439033376",
        "submitterId": "009998999898",
        "customerClaimNumber": "000000001",
        "patientControlNumber": "12345",
        "timeOfResponse": "2020-03-31T16:41:00.895-05:00",
        "claimType": "INS"
    },
    "errors": [
        {
            "field": "03",
            "value": "981010000",
            "description": "When entered, the Billing Provider Postal Code must be nine numeric characters and valid for the state.\n\nLOOP 2010AA N403",
            "location": "2010AA N4"
        }
    ]
}

The error reports the X12 loop and segment where the incorrect value occurred. It corresponds to the postalCode attribute in the subscriber object.

Also check the Error Messages in Institutional Claims topic for more information.

NOTE: We recommend using the Validation API before sending the claim request to the payer. Validation rules help prevent claims with incorrect information from being sent to the payer, such as a typo in the NPI, errors in calculations, or poor formatting and syntax in the claim. You can also use the Professional Claims Healthcheck API to check on the operating status of the service endpoint before sending the claim.

Did this page help you?